This web site is provided for
information and education purposes only. No doctor/patient
relationship is established by your use of this site. No
diagnosis or treatment is being provided. The information
contained here should be used in consultation with a dentist of
your choice. No guarantees or warranties are made
regarding any of the information contained within the web site.
This web site is not intended to offer specific medical or
dental advice to anyone. Todd S. Milne, D.D.S. are
licensed to practice in the state of Nevada and this web site is
not intended to solicit patients from other states.
Further, this web site and Todd S. Milne, D.D.S. take no
responsibility for web sites hyper-linked to this site and such
hyper-linking does not imply any relationships or endorsements.

Copyright: Information and names
within this web site may be subject to copyright and trademark
protection with all rights reserved. Duplication or use without
the expressed written permission by Todd S. Milne, D.D.S. subjects the
violator to both civil and criminal penalties.

These Health Information Privacy Policies &
Procedures implement our obligations to protect the privacy of
individually identifiable health information that we create, receive, or
maintain as a healthcare provider.

We implement these Health Information Privacy
Policies and Procedures as a matter of sound business practice; to
protect the interests of our patients; and to fulfill our legal
obligations under the Health Insurance Portability and Accountability
Act of 1996 ("HIPAA"), its implementing regulations at 45 CFR Parts 160
and 164 (65 Fed. Reg 82462 (Dec. 28, 2000)) ("Privacy Rules"), as
amended (67 Fed. Reg. 53182 [Aug. 14, 2002]), and state law that
provides greater protection or rights to patients than the Privacy
Rules.

As a member of our workforce or as our Business
Associate, you are obligated to follow these Health Information Privacy
Policies & Procedures faithfully. Failure to do so can result in
disciplinary action, including termination of your employment or
affiliation with us.

These Policies & Procedures address the basics of
HIPAA and the Privacy Rules that apply in our dental practice. They do
not attempt to cover everything in the Privacy Rules. The Policies &
Procedures sometimes refer to forms we use to help implement the
policies and to the Privacy Rules themselves when added detail may be
needed.

Please note that while the Privacy Rules speak in
terms of "individual" rights and actions, these Policies & Procedures
use the more familiar word "patient" instead; "patient" should be read
broadly to include prospective patients, patients of record, former
patients, their authorized representatives, and any other "individuals"
contemplated in the Privacy Rules.

If you have questions or doubts about any use or
disclosure of individually identifiable health information or about your
other obligations under these Health Information Privacy Policies &
Procedures, the Privacy Rules or other federal or state law, please
contact our office. This policy was adopted effective 4/14/03

Our dental office must not use or disclose
protected health information (PHI), except as these Privacy Policies
& Procedures permit or require.

2. Acknowledgement and Optional Consent

Our dental office will make a good faith effort to
obtain a written acknowledgement of receipt of our Notice of Privacy
Practices (see Section 9) from a patient before we use or disclose
his or her protected health information (PHI) for treatment, to obtain
payment for that treatment, or for our healthcare operations (TPO).

Our dental office’s use or disclosure of PHI for our
payment activities and healthcare operations may be subject to the
minimum necessary requirements (see Section 7).

Our dental office will become familiar with our
state’s privacy laws. If required by our state law, or as directed by
the dentist, we will also seek Consent from a patient before we
use or disclose PHI for TPO purposes – in addition to obtaining an
Acknowledgement of receipt of our Notice of Privacy Practices.

a) Obtaining Consent – If consent is to be obtained, upon the
individual’s first visit as a patient (or next visit if already a
patient), our dental office will request and obtain the patient’s
written Consent for our use and disclosure of the patient’s
PHI for treatment, payment, and healthcare operations.

Any consent we obtain must be on our Consent
form, which we may not alter in any way. Our dental office will
include the signed Consent form in the patient’s chart.

b)Exceptions
– Our dental office does not have to obtain the patient’s Consent in
emergency treatment situations; when treatment is required by law;
or when communications barriers prevent consent.

c)Consent
Revocation – A patient from whom we obtain consent may revoke it
at any time by written notice. Our dental office will include the
revocation in the patient’s chart. There is space at the bottom of
our Consent form where the patient can revoke the consent.

d) Applicability
– Consent for use or disclosure of PHI should not be confused with
informed consent for dental treatment. This section applies to our
practice.

3. Authorization

In some cases we must have proper, written
Authorization from the patient (or the patient’s personal
representative) before we use or disclose a patient’s PHI for any
purpose (except for TPO purposes) or as permitted or required without
consent or authorization (see Sections 3, 4, or 5).

Our dental office will use the Authorization
form. We will always act in strict accordance with an Authorization.

a)Authorization
Revocation – A patient may revoke an authorization at any time by
written notice. Our dental office will not rely on an Authorization
we know has been revoked.

b)Authorization
from Another Provider – Our dental office will use or disclose PHI
as permitted by a valid Authorization we receive from another
healthcare provider.

Our dental office may rely on that covered entity to
have requested only the minimum necessary protected PHI. Therefore, our
dental office will not make our own "minimum necessary" determination,
unless we know that the Authorization is incomplete, contains
false information, has been revoked, or has expired.

c)Authorization
Expiration – Our dental office will not rely on an Authorization
we know has expired.

4. Oral Agreement

Our dental office may use or disclose a patient’s PHI
with the patient’s Oral Agreement or if the patient is
unavailable subject to all applicable requirements.

Our dental office may use professional judgment and
our experience with common practice to make reasonable inferences of the
patient’s best interest in allowing a person to act on behalf of the
patient to pick up dental/medical supplies, X-rays, or other similar
forms of PHI.

Our dental office may use or disclose a patient’s PHI
in certain situations, without Authorization or Oral Agreement.
In our dental office, these disclosures are not likely to be frequent.

a) Verification of Identity
– Our dental office will always verify the identity of any patient, and
the identity and authority of any patient’s personal representative,
government or law enforcement official, or other person, unknown to us,
who requests PHI before we will disclose the PHI to that person.

Our dental office will obtain appropriate
identification and, if the person is not the patient, evidence of
authority. Examples of appropriate identification include photographic
identification card, government identification card or badge, and
appropriate document on government letterhead. Our dental office will
document the incident and how we responded.

b)Uses or
Disclosures Permitted under this Section 5 – The situations in which
our dental office is permitted to use or disclose PHI in accordance with
the procedures set out in this Section 5 are listed below.

Our dental office may disclose a patient’s PHI to
that patient on request.

Our dental office may disclose to a patient’s
personal representative PHI relevant to the representative capacity.
We will not disclose to a personal representative we reasonably
believe may be abusive to a patient any PHI we reasonably believe
may promote or further such abuse.

Our dental office will not use or disclose a
patient’s PHI for fundraising purposes without the patient’s
Authorization.

Our dental office will not use or disclose PHI
for marketing without a patient’s Authorization unless the
marketing is in the form of a promotional gift of nominal value that
we provide, or face-to-face communications between us and the
patient.

Our dental office may use or disclose PHI in the
following types of situations, provided procedures specified in the
Privacy Rules are followed:

For public health activities;

To health oversight agencies;

To coroners, medical examiners, and funeral
directors;

To employers regarding work-related illness or
injury;

To the military;

To federal officials for lawful intelligence,
counterintelligence, and national security activities;

To correctional institutions regarding inmates;

In response to subpoenas and other lawful
judicial processes;

To law enforcement officials;

To report abuse, neglect, or domestic violence;

As required by law;

As part of research projects; and

As authorized by state worker’s compensation
laws.

6. Required Disclosures

Our dental office will disclose protected health
information (PHI) to a patient (or to the patient’s personal
representative) to the extent that the patient has a right of access to
the PHI (see Section 10); and to the U.S. Department of Health and Human
Services (HHS) on request for complaint investigation or compliance
review.

Our dental office will use the disclosure log to
document each disclosure we make to HHS.

Our dental office will make reasonable efforts to
disclose, or request of another covered entity, only the minimum
necessary protected health information (PHI) to accomplish the
intended purpose.

There is no minimum necessary requirement for
disclosures to or requests by one another in our dental office or by a
healthcare provider for treatment; permitted or required disclosures to,
or for disclosure requested and authorized by, a patient; disclosures to
HHS for compliance reviews or complaint investigations; disclosures
required by law; or uses or disclosures required for compliance with the
HIPAA Administrative Simplification Rules.

a) Routine or Recurring Requests or Disclosures
– Our dental office will follow the policies and procedures that we
adopt to limit our routine or recurring requests for our disclosures of
PHI to the minimum reasonably necessary for the purpose.

b) Non-Routine or Non-Recurring Requests or
Disclosures – No non-routine or
non-recurring request for or disclosure of PHI will be made until it has
been reviewed on a patient-by-patient basis against our criteria to
ensure that only the minimum necessary PHI for the purpose is requested
or disclosed.

c) Other’s Requests –
Our dental office will rely, if reasonable for the situation, on a
request to disclose PHI being for the minimum necessary, if the
requester is: (a) a covered entity; (b) a professional (including an
attorney or accountant) who provides professional services to our
practice, either as a member of our workforce or as our Business
Associate, and who represents that the requested information is the
minimum necessary; (c) a public official who represents that the
information requested is the minimum necessary; or (d) a researcher
presenting appropriate documentation or making appropriate
representations that the research satisfies the applicable requirements
of the Privacy Rules.

d) Entire Record – Our
dental office will not use, disclose, or request an entire record,
except as permitted in these Policies & Procedures or standard protocols
that we adopt reflecting situations when it is necessary.

Our dental office will obtain satisfactory assurance
in the form of a written contract that our Business Associates
will appropriately safeguard and limit their use and disclosure of the
protected health information (PHI) we disclose to them.

These Business Associate requirements are not
applicable to our disclosures to a healthcare provider for treatment
purposes. The Business Associate Contract Terms document contains
the terms that federal law requires be included in each Business
Associate Contract.

a.)
Breach by Business Associate
– If our dental office learns that a Business Associate has
materially breached or violated its Business Associate Contract
with us, we will take prompt, reasonable steps to see that the breach or
violation is cured.

If the Business Associate does not promptly
and effectively cure the breach or violation, we will terminate our
contract with the Business Associate, or if contract termination
is not feasible, report the Business Associate’s breach or
violation to the U.S. Department of Health and Human Services (HHS).

9. Notice of Privacy Practices

Our dental office will maintain a Notice of
Privacy Practices as required by the Privacy Rules.

a) Our Notice – Our
dental office will use and disclose PHI only in conformance with the
contents of our Notice of Privacy Practices. We will promptly
revise a Notice of Privacy Practices whenever there is a material
change to our uses or disclosures of PHI to legal duties, to the
patients’ rights or to other privacy practices that render the
statements in that Notice no longer accurate.

Form 1, Notice of Privacy Practices, found in this
Privacy Kit, contains the terms that federal law requires.

b) Distribution of Our Notice
– Our dental office will provide our Notice of Privacy Practices
to any person who requests it, and to each patient no later than the
date of our first service delivery after April 14, 2003.

Our dental office will have our Notice of Privacy
Practices available for patients to take with them. We will also
post our Notice of Privacy Practices in a clear and prominent
location where it is reasonable to expect patients seeking services from
us will be able to read the Notice.

c) Acknowledgement of Notice
– Our dental office will make a good faith effort to obtain from the
patient a written Acknowledgement of receipt of our Notice of Privacy
Practices.

Our dental office shall use Form 2,
Acknowledgement of Receipt of Notice of Privacy Practices, found in
this Privacy Kit, to obtain the Acknowledgement. If we cannot obtain
written Acknowledgement from the patient, we will use the form to
document our attempt and the reason why written Acknowledgement was not
signed by the patient.

Our dental office will honor the rights of patients
regarding their PHI.

a) Access – With rare
exceptions, our dental office must permit patients to request access to
the PHI we or our Business Associates hold.

No PHI will be withheld from a patient seeking access
unless we confirm that the information may be withheld according to the
Privacy Rules. We may offer to provide a summary of the information in
the chart. The patient must agree in advance to receive a summary and to
any fee we will charge for providing the summary. Our dental office will
contact our Business Associates to retrieve any PHI they may have
on the patient.

b) Amendment – Patients
have the right to request to amend their PHI and other records for as
long as our dental office maintains them.

Our dental office may deny a request to amend PHI or
records if: (a) we did not create the information (unless the patient
provides us a reasonable basis to believe that the originator is not
available to act on a request to amend); (b) we believe the information
is accurate and complete; or (c) we do not have the information.

Our dental office will follow all procedures required
by the Privacy Rules for denial or approval of amendment requests. We
will not, however, physically alter or delete existing notes in a
patient’s chart. We will inform the patient when we agree to make an
amendment, and we will contact our Business Associates to help
assure that any PHI they have on the patient is appropriately amended.
We will contact any individuals whom the patient requests we alert to
any amendment to the patient’s PHI. We will also contact any individuals
or entities of which we are aware that we have sent erroneous or
incomplete information and who may have acted on the erroneous or
incomplete information to the detriment of the patient.

When we deny a request for an amendment, we will mark
any future disclosures of the contested information in a way
acknowledging the contest.

c) Disclosure
Accounting – Patients have the right to an accounting of certain
disclosures our dental office made of their PHI within the 6 years prior
to their request. Each disclosure we make, that is not for treatment
payment or healthcare operations, must be documented showing the date of
the disclosure, what was disclosed, the purpose of the disclosure, and
the name and (if known) address of each person or entity to whom the
disclosure was made. The Authorization or other documentation
must be included in the patient’s record. We use the patient’s chart to
track each disclosure of PHI as needed to enable us to fulfill our
obligation to account for these disclosures.

We are not required to account for disclosures we
made: (a) before April 14, 2003; (b) to the patient (or the patient’s
personal representative); (c) to or for notification of persons involved
in a patient’s healthcare or payment for healthcare; (d) for treatment,
payment, or healthcare operations; (e) for national security or
intelligence purposes; (f) to correctional institutions or law
enforcement officials regarding inmates; or (g) according to an
Authorization signed by the patient or the patient’s representative; (h)
incident to another permitted or required use disclosure.

We will temporarily suspend the accounting of any
disclosure when requested to do so pursuant according to the Privacy
Rules by health oversight agencies or law enforcement officials. We may
charge for any accounting that is more frequent than every 12 months,
provided the patient is informed of the fee before the accounting is
provided. We will contact our Business Associates to assure we
include in the accounting any disclosures made by them for which we must
account.

d) Restriction on Use or Disclosure
– Patients have the right to request our dental office to restrict use
or disclosure of their PHI, including for treatment, payment, or
healthcare operations. We have no obligation to agree to the request,
but if we do, we will comply with our agreement (except in an
appropriate dental/medical emergency).

We may terminate an agreement restricting use or
disclosure of PHI by a written notice of termination to the patient. We
will contact our Business Associates whenever we agree to such a
restriction to inform the Business Associate of the restriction
and its obligations to abide by the restriction. We will document in the
patient’s chart any such agreed to restrictions.

e) Alternative Communications –
Patients have the right to request us to use alternative means or
alternative locations when communicating PHI to them. Our dental office
will accommodate a patient’s request for such alternative communications
if the request is reasonable and in writing.

Our dental office will inform the patient of our
decision to accommodate or deny such a request. If we agree to such a
request, we will inform our Business Associates of the agreement and
provide them with the information necessary to comply with the
agreement.

f) Applicability – Our
dental office will be aware of and respect these patients’ rights
regarding their PHI, even though in most situations patients are
unlikely to exercise them.

* Training – Our dental
office will train all members of our workforce in these Privacy Policies
& Procedures, as necessary and appropriate for them to carry out their
functions. We will complete the privacy training of our existing
workforce by April 14, 2003.

After April 14, 2003, our dental office will train
each new staff member within a reasonable time after the member starts.
We will also retain each staff member whose functions are affected
either by a material change in our Privacy Policies and Procedures or in
the member’s job functions, within a reasonable time after the change.

Form 7, Staff Review of Policies and Procedures,
can be used to have workforce members acknowledge they have received and
read a copy of these Policies and Procedures.

Staff members who violate our Privacy Policies &
Procedures, the Privacy Rules or other applicable federal or state
privacy law will be subject to disciplinary action, possibly up to and
including termination of employment.

b) Complaints – Our
dental office will implement procedures for patients to complain about
our compliance with our Privacy Policies and Procedures or the Privacy
Rules. We will also implement procedures to investigate and resolve such
complaints.

The Complaint form can be used by the patient
to lodge the complaint. Each complaint received must be referred to
management immediately for investigation and resolution. We will not
retaliate against any patient or workforce member who files a
Complaint in good faith.

c) Data Safeguards –
Our dental office will "add to" and strengthen these Privacy Policies &
Procedures with such additional data security policies and procedures as
are needed to have reasonable and appropriate administrative, technical,
and physical safeguards in place to ensure the integrity and
confidentiality of the PHI we maintain.

Our dental office will take reasonable steps to limit
incidental uses and disclosures of PHI made according to an otherwise
permitted or required use or disclosure.

d) Documentation and Record Retention
– Our dental office will maintain in written or electronic form all
documentation required by the Privacy Rules for six years from the date
of creation or when the document was last in effect, whichever is
greater.

Our dental office will comply with the privacy laws
of each state that has jurisdiction over our practice, or its actions
involving protected health information (PHI), that provide greater
protections or rights to patients than the Privacy Rules.

13. HHS Enforcement

Our dental office will give the U.S. Department of
Health and Human Services (HHS) access to our facilities, books,
records, accounts, and other information sources (including individually
identifiable health information without patient authorization or notice)
during normal business hours (or at other times without notice if HHS
presents appropriate lawful administrative or judicial process).

We will cooperate with any compliance review or
complaint investigation by HHS, while preserving the rights of our
practice.

14. Designated Personnel

Our dental office will designate a Privacy Officer
and other responsible persons as required by the Privacy Rules.